Provider Enrollment Specialist
2 weeks ago
We are seeking a highly skilled and detail-oriented Provider Enrollment Specialist to join our team at Highmark Health. In this role, you will be responsible for coordinating and facilitating the enrollment of Allegheny Clinic professional providers with various payers for professional services reimbursement.
Key Responsibilities- Coordinate and facilitate provider enrollment with payers, ensuring timely and accurate completion of applications.
- Review and verify provider credentialing and recredentialing data for accuracy, ensuring compliance with licensing requirements and payer regulations.
- Obtain and update provider information from various sources, including provider offices, state licensing boards, and malpractice insurance companies.
- Identify and resolve issues related to provider enrollment and credentialing, maintaining positive working relationships with providers and practice/office managers.
- Develop and maintain databases and spreadsheets for tracking provider enrollment and credentialing status.
- Continuously search for process improvements to achieve accuracy and efficiency in provider enrollment and credentialing.
- 2 years of experience in a physician medical practice with a basic understanding of payer billing requirements and claims processing.
- Advanced computer skills using word, excel, adobe, and web-based applications.
- Excellent customer service, follow-up, and communication skills.
- Associate's degree.
- Certified Provider Credentialing Support (CPCS) by the National Association Medical Staff Services.
- Experience with ECHO and/or professional provider credentialing.
- Delegated credentialing experience.
- Experience with Cactus and/or other professional provider credentialing software.
Highmark Health is an equal opportunity employer and prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibits discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity, or any other category protected by applicable federal, state, or local law.
We offer a competitive salary range of $20.15 to $30.93, depending on qualifications and experience.
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